Tuesday, January 3, 2017

Nearly all historians agree that the battle of Gettysburg was the turning point of the American Civil War. It was also, one of the bloodiest battles of the Civil War. In this three day struggle, over fifty thousand soldiers were killed or wounded. Gettysburg, like other Civil War battles, is remembered for the horror that occurred on the battlefield. There was, however, plenty of horror that took place off the battlefield. The wounded were at the mercy of the battlefield surgeons. Many times, unfortunately, these surgeons were simply incompetent.

There were many surprises in the Civil War. The biggest surprise of all was just how incomprehensibly unprepared they were for the deadly battle results. By the age of 15, most young men are enjoying life: sports, girls, cars, or playing Candy Crush on their iPhones. The ambitious ones, might even work part-time at Safeway. Just a short century and a half ago young Seymour Goodyear spent his teenage days doing something very different. Seymour was a farm boy from Georgia, but in the early 1860’s his name turned up in the staff registrar of St. Charles Hospital in Richmond, Virginia. Listed as a hospital steward, in the course of the Civil War, he assisted surgeons performing amputations and, in many cases, he performed them himself.

Men and boys made up the surgical corps of both armies. Aurelius Barlett was formerly a gold miner in Colorado, but he performed his duties as a surgeon for the 33rd Missouri infantry. A U. S. Marshal, David V. Whitney was made a surgeon, too, and placed in charge of an entire hospital. Both men, and many others, had no training or experience. Many were politically appointed. Some were dodging regular duty on the battlefield. Others simply found themselves needed because of the overwhelming numbers of casualties. Having a 15-year-old farm boy, or a gold miner or marshal, stand over you with a knife, could not have inspired confidence. It is also unlikely that many performing the amputations had even seen a dead body before. Consider the terrible sight of a battlefield hospital: seriously injured soldiers waiting their turn, and in full view of the mass amputations taking place.

There were, however, a small group of real doctors, those who had actually gone to medical school. In a letter to his wife, Dr. Daniel Holt describes in stunned disbelief his battlefield observations: “Every house, for miles around is a hospital, and I have seen arms, legs, feet, and hands lying in piles rotting in the blazing heat of the Southern sky, unburied and uncared for, and still the knife went steadily in its work to the putrid mess.” Holt’s words are disturbing but give a small window into history as it was happening.

There was, however, one word that can best describe the surgical procedure most used during the Civil War – amputation. Some surgeons tried to preserve limbs by resection, but amputation was the preferred method. Since the Civil War some historians, educators and others have complained vehemently about the overuse of the “knife.” Butchers, savages, drunken boy surgeons, and many more, were some of the words used to describe and rail against Civil War surgeons. The soldiers also held a low opinion of surgeons, one stating: “it has ever been my opinion that a man is no better than a dead man when placed under the hands of almost any of our surgeons.” Battlefield nurses even chimed in, “it grieves me to think of how many men are ruined for life by surgeons who with savage glee hurry to chop off arms, legs, ad libitum, who might by a slower and more skillful process have been saved such humiliation.” Others have referred to the surgeons as murderers and drunken murderers. Not so fast! It could be argued that the conditions of war demanded simple surgical procedures. A surgeons work needed to be without complications, since the majority of them had little or no medical training.

Amputation was a simple answer. It was fast and uncomplicated, taking less than ten minutes to remove a limb and it required only a few instruments. The knives and saws were tools that were familiar even to the untrained. The medical corps were overwhelmed, sometimes facing as many as 35,000 casualties in one battle. Additionally, even if the surgeon tried to save a limb, instead of amputating, it would have been very risky. Let’s remember that antibiotics did not exist at that time and conservative surgery would have increased the chance of infection and the patient would certainly die.

Battlefield surgeons also had to consider the time element. Conservative surgery would have taken far longer than ten minutes. Decisions were made quickly. Most successful surgeries were performed within 24 hours of the wounding. The last to be seen were usually those shot in the head, chest, or stomach and nearly always left to die. Surgeons focused on those who had a chance of surviving.

There is little doubt that many of the complaints made against Civil War surgeons were true. There were others who were good, even excellent, and continued as surgeons after the war. Despite the high number of complaints about Civil War surgeons, there was a 75% survival rate of all surgeries. The battlefield was the training ground for Civil War surgeons.